HHS officials said the proposed rule on the accommodation clarifies a proposal issued last year to ensure that women who work for not-for-profit religiously affiliated employers can access no-cost contraceptive coverage under the Affordable Care Act (PL 111-148). Chiquita Brooks-LaSure of HHS' Office of Health Reform said the accommodation ensures that employees have access to contraceptive coverage and that a religiously affiliated employer does not have "to arrange, contract, pay or refer for" it (Rovner, "Shots," NPR, 2/1).

The proposed rule did not extend the accommodation to owners of private, for-profit businesses who have religious objections to covering contraception. Kyle Duncan -- general counsel for the Becket Fund for Religious Liberty, which has filed several lawsuits against the rules on behalf of businesses -- said, "We were hoping for much, much more from the administration" (Kumar/Clark, McClatchy/Miami Herald, 2/1). The Wall Street Journal notes that many opponents of the contraceptive coverage rules have said they will not be satisfied unless the requirements are eliminated altogether (Wall Street Journal, 2/2).

Two of the most influential Catholic organizations -- the U.S. Conference of Catholic Bishops and the Catholic Health Association, which represents Catholic hospitals -- did not immediately weigh in on the proposal (Politico, 2/1). Cardinal Timothy Dolan of USCCB issued a brief statement Friday, saying that the group will "issu[e] a more detailed statement later" (Kliff/Boorstein, Washington Post, 2/2).

National Association of Evangelicals President Leith Anderson said the administration should have eliminated the contraceptive coverage rules completely or "at least should have exempted all religious organizations" (Ruggles, Omaha World-Herald, 2/1).

Timothy Jost, a Washington and Lee law professor who supports the ACA, said, "I would imagine that if you go to the Pro-Life websites you'll find lots and lots of cries of anguish, ... but [the accommodation] does address the issue: Religious organizations are not going to have to pay for contraception" (Politico, 2/1).

NARAL Pro-Choice America President Ilyse Hogue said, "Today's draft regulation affirms yet again the Obama administration's commitment to fulfilling the full promise of its historic contraception policy," adding, "Thanks to this commitment, most American women will get birth-control coverage without extra expense" (Washington Post, 2/2).

Insurers React

Insurers are still studying the proposal but also questioned some aspects, including how they would pay for contraception if they cannot "impose any premium, fee or other charge" for coverage, as stated under the proposed rule. Further, the proposal would bar insurers from imposing annual or lifetime limits on the dollar value of contraceptive coverage, although it states that "the cost of the contraceptive coverage could include a reasonable margin," or profit, for insurers. Insurers said that the costs would be transferred to consumers.

For religious employers that self-insure, the proposal would require outside insurers to provide the contraception coverage. In return, the federal government would lower the user fees that these insurers must pay to participate in the federally led health insurance exchanges.

Brooks-LaSure said the user fees are "private dollars paid by private insurers that choose to operate in the exchanges," noting that they were "not a cost to the federal government or to taxpayers" (Pear, New York Times, 2/1).